J Neurol Sci 2021 Jan 15;421:117308. .
Susceptibility-weighted imaging reveals cerebral microvascular injury in severe COVID-19
John Conklin 1, Matthew P Frosch 2, Shibani S Mukerji 3, Otto Rapalino 4, Mary D Maher 4, Pamela W Schaefer 4, Michael H Lev 4, R G Gonzalez 4, Sudeshna Das 3, Samantha N Champion 5, Colin Magdamo 3, Pritha Sen 6, G Kyle Harrold 3, Haitham Alabsi 3, Erica Normandin 7, Bennett Shaw 8, Jacob E Lemieux 6, Pardis C Sabeti 7, John A Branda 9, Emery N Brown 10, M Brandon Westover 3, Susie Y Huang 1, Brian L Edlow 11
Affiliations collapse
Affiliations
- 1 Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States of America.
- 2 C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.
- 3 Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.
- 4 Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.
- 5 C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Boston, MA, USA.
- 6 Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.
- 7 Broad Institute, Massachusetts Institute of Technology and Harvard University, Cambridge, MA, United States of America.
- 8 Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America; Broad Institute, Massachusetts Institute of Technology and Harvard University, Cambridge, MA, United States of America.
- 9 Department of Pathology, Massachusetts General Hospital and Harvard Medical School, United States of America.
- 10 Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.
- 11 Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States of America; Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, United States of America; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America. Electronic address: bedlow@mgh.harvard.edu.
Abstract
We evaluated the incidence, distribution, and histopathologic correlates of microvascular brain lesions in patients with severe COVID-19. Sixteen consecutive patients admitted to the intensive care unit with severe COVID-19 undergoing brain MRI for evaluation of coma or neurologic deficits were retrospectively identified. Eleven patients had punctate susceptibility-weighted imaging (SWI) lesions in the subcortical and deep white matter, eight patients had >10 SWI lesions, and four patients had lesions involving the corpus callosum. The distribution of SWI lesions was similar to that seen in patients with hypoxic respiratory failure, sepsis, and disseminated intravascular coagulation. Brain autopsy in one patient revealed that SWI lesions corresponded to widespread microvascular injury, characterized by perivascular and parenchymal petechial hemorrhages and microscopic ischemic lesions. Collectively, these radiologic and histopathologic findings add to growing evidence that patients with severe COVID-19 are at risk for multifocal microvascular hemorrhagic and ischemic lesions in the subcortical and deep white matter.
Keywords: COVID-19; Coma; MRI; Susceptibility-weighted imaging.
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